Surgery for endometriosis-associated infertility: a pragmatic approach.
Laparoscopic treatment for endometriosis-associated infertility is gaining widespread popularity supported mostly by uncontrolled studies, but the purported benefit of surgery may be overvalued. We have therefore analysed the best available evidence with the aim of defining an approximate estimate of the effect size of conservative surgery for infertile women with endometriosis in various clinical conditions. The overall increase in post-operative likelihood of conception over background pregnancy rate may be estimated to be between 10 and 25%. The effect of surgery for peritoneal lesions is limited, and an estimate of benefit should be decreased by the fact that preoperative identification of the subjects actually with the condition is unfeasible. The benefit of excision of ovarian endometriomas is difficult to define due to multiple confounding factors and methodological drawbacks in the considered studies. Excision of rectovaginal endometriosis is of doubtful value and associated with worrying morbidity. The role of surgery before, after or as an alternative to IVF needs clarification. In conclusion, the absolute benefit increase of surgery for endometriosis-associated infertility appears smaller than previously believed. Complete and detailed information on risks and benefits of treatment alternatives must be offered to infertile patients to allow unbiased choices between possible options.
Vercellini
Paolo
P
Gynaecologic Surgery Division, Department of Obstetrics and Gynaecology, University of Milan, via Commenda 12, 20122 Milano, Italy. paolo.vercellini@unimi.it
Somigliana
Edgardo
E
Viganò
Paola
P
Abbiati
Annalisa
A
Barbara
Giussy
G
Crosignani
Pier Giorgio
PG
D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D004715:Endometriosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005307:Fertilization in Vitro; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D007247:Infertility, Female / Q000209:etiology* / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D018873:Pregnancy Rate; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors